There's a new, more sensitive way to screen for cervical cancer  yet only 15 percent of doctors are using it. Why the Pap may no longer be enough.

Suppose there were a screening test for cervical cancer that could detect potential dangers with far more sensitivity than the Pap. A test so reliable that when it was done with the Pap, you could trust the results nearly 100 percent. Sounds like all women would be getting it, right? Well...there is such a screen  the HPV test. It's been approved by the FDA and endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society as an option to be done with your Pap, and yet only an estimated 15 percent of doctors are using it. If your ob-gyn has never mentioned it, read on. Understanding the limits of the Pap and what the new test can do, and getting updated info on who's at risk of cervical cancer, will help you start the conversation.

What is the new HPV test?
Almost all cervical cancers are caused by prior infection with human papillomavirus, or HPV. There are more than 100 strains of HPV, about 40 of which can be spread by having sex. Some cause warts, others no symptoms at all. But some types cause cell abnormalities in the lining of the cervix that, years later, can become malignant. Two of these strains  numbers 16 and 18  are thought to be responsible for roughly 70 percent of cervical cancer cases. The HPV test literally homes in on genetic coding that occurs in these two, plus about a dozen other high-risk strains. A negative HPV test means that no active virus could be found; a positive result, that one or more of those strains is present.

How is this different from the Pap?
The Pap is designed for visual identification (by either lab technician or computer) of any cells that look abnormal. The HPV test was originally approved by the FDA as a follow-up for women whose Pap results were ambiguous (technically called ASCUS  "atypical squamous cells of undetermined significance"), a category that may affect some three million women every year. Now it's been OK'd as a screening test for women 30 and over, to be done with the Pap and, generally, the same sample of cervical cells.

How effective is it?
Last April, two scientists from the National Cancer Institute, writing in the prestigious New England Journal of Medicine about a study of 131,746 women in India, said that "among...women between the ages of 30 and 59 years...a single HPV test performed 15 to 20 years after the median age of first sexual intercourse will detect many easily treatable, persistent infections and precancers while limiting overtreatment." One test, they wrote, "dramatically reduced the incidence of advanced cervical cancer and cervical cancer mortality."

Why improve on the Pap?
This one test has made a huge difference in the health of American women; since the Pap's introduction in the 1940s, cervical cancer rates have been slashed by 70 percent, to 11,270 cases and 4,070 deaths in 2009. But the test has problems. For one, a single Pap can miss up to 50 percent of cell abnormalities (but because these changes usually occur very slowly, chances are great that an abnormality will be picked up on your next test). The Pap can also raise a false alarm when nothing's really wrong: Cervical tissue undergoes surface changes all the time, and these may pop up on your Pap, then disappear on their own. No screen can ever be considered 100 percent perfect, but the Pap/HPV combo comes pretty close. Studies from the U.S. and Europe show if you have negative results on the two tests given together, you can be 99.84 percent assured you won't develop cervical cancer within the next three or more years, says Alan G. Waxman, M.D., M.P.H., professor of obstetrics and gynecology at the University of New Mexico School of Medicine and lead author of the cervical-screening guidelines published by ACOG last December.

Do you still need an annual Pap test?
Actually, since 1987, virtually every medical organization that has issued guidelines on cervical screening has endorsed the idea that after three successive "normals," a healthy, low-risk woman age 30 or over needs to be tested only every two to three years. "The tradition of annual Pap tests is just that, a tradition, and it's not backed up by science," says Debbie Saslow, Ph.D., the American Cancer Society's director of breast and gynecologic cancers. Only women considered at high risk  DES daughters, for example, or those who've had cervical cancer or precancerous lesions  need more frequent tests. (Smoking also ups your risk; if you smoke, ask about extra tests.) Even if you don't have a Pap, though, you should have regular checkups that include breast and pelvic exams, a blood pressure reading, and other tests depending on your age and medical history.

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